Clinical decision-support only. For use by licensed dental professionals. Not a substitute for professional judgment or a complete drug reference. Always verify with primary sources.
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Medication

Mirtazapine

Antidepressant (atypical)

Brand names: Remeron

Oral health effects

  • Xerostomia (dry mouth)

    Reduced salivary flow raising caries, candidiasis, and mucosal discomfort risk.

    Clinical management: Hydration, sugar-free gum/xylitol, salivary substitutes, high-fluoride products; reinforce caries prevention.

  • Agranulocytosis (rare; may present as mouth ulcers)

    In premarketing trials 2 of 2,796 patients developed agranulocytosis. The label tells patients to report sore throat, fever or stomatitis, which can be the first sign.

    Clinical management: Mouth ulcers, unexplained gingival infection or sore throat with fever in a patient on mirtazapine warrant prompt referral to the prescriber for a blood count; defer elective invasive treatment until the result is known.

Sources

  1. A Guide to Medications Inducing Salivary Gland Dysfunction, Xerostomia, and Subjective Sialorrhea: A Systematic Review Sponsored by the World Workshop on Oral Medicine VI. Wolff A, Joshi RK, Ekström J, et al. Drugs in R&D, 2017.
  2. Adverse drug events in the oral cavity. Yuan A, Woo SB. Oral surgery, oral medicine, oral pathology and oral radiology, 2015.
  3. Mirtazapine prescribing information (FDA label) Bryant Ranch Prepack / DailyMed, 2023.